Tag: Confidence

Originally published in July 2019 edition, ASA Monitor (citation below)

‘Unexpected death of a colleague,’ I read in the subject line.

As I combed through the remainder of the email, I came to learn that a second-year resident had died in a car accident near his hometown. It was his name that gave me pause.

Just a few weeks prior, I entered one of the campus cafeterias for a meal. There, I noticed a young man sitting alone wearing a navy-blue jacket. A University of Pennsylvania Perelman School of Medicine crest was stitched on his chest.

“Hey, man – I happened to notice your jacket. Did you attend UPenn?”

“Yeah, I did. I’m Joe! Nice to meet you.”

“It’s nice to meet you, too. A few of my closest friends also graduated from there!” I replied.

A conversation started, just pleasant banter that danced around the east coast versus west coast biases, shared colleagues and friends, Portland’s city designation with its small-town charm, and our respective medical specialties. The dialogue was short but delightful and lasted approximately five minutes in total. Before I left his table, I suggested we take a photo together to send to our mutual friends.

Our smiles are in my phone now.

In the five minutes when we spoke, a connection was formed, a foundation of trust laid. Unlikely as it seemed at the time, this simple exchange was similar to the swiftly created bond that forms when an anesthesiologist talks to their patient prior to surgery.

When I was a fourth-year medical student, I told my family and friends that I had applied to an anesthesiology residency program. Their responses varied. Most were happy but they had questions too, specifically concerns that my communication skills would be “wasted.” Knowing how much joy interacting with people brings me, they were disappointed that I would spend most of my medical practice with unconscious patients. My answer: there is a unique responsibility born in that five-minute interaction prior to surgery. In those five minutes, I may have the ability to connect to a patient, gain trust and portray a sense of safety to a complete stranger in a way someone else may not. My communication skills could be the difference between someone entering the operating room with wild fear or measured ease.

When I was a fourth-year medical student, I told my family and friends that I had applied to an anesthesiology residency program. Their responses varied. Most were happy but they had questions too, specifically concerns that my communication skills would be ‘wasted.’

I am not alone in feeling this way. “I have five minutes to convince someone I can take care of their life,” Dr. Marshall Lee – Oregon Health & Science University (OHSU) attending physician – stressed during residency orientation. This time restraint is a challenge that should be decorated for anesthesiology rather than seen as a reason to choose another specialty. A patient waiting in the preoperative area is possibly in one of the most vulnerable states of their lives. Patients may find themselves anxiety-stricken for the surgery itself, fearful regarding the aftermath, pained by the financial burden of the surgery and concerned for the risk of death. Most encounters we have with our patients are brief and delicate. A patient in this highly vulnerable state – concomitant with a short window of time – clings to every word from our lips. After a postoperative call to verify the patient is recovering appropriately, it is probable you will never see nor hear from them again. This does not detract from the memory of how you made them feel – one they may carry with them for a lifetime.1

When recalling my conversation with Joe, I can no longer remember the nuances nor the minute details, yet I felt more connection and delight upon walking away from the table that day than after many hour-long discussions with others. As anesthesiologists, we only have a few minutes to gain the trust of the patient and family member, positively frame one’s outlook prior to their surgery, and provide the sense of comfort and reassurance they are seeking. During this brief encounter, we must gather information, set expectations and address concerns a patient may have – several factors underlying high-quality patient-physician encounters.2One underestimated key is non-verbal communication – a grounding component of a therapeutic patient-physician relationship.1And one example of this is evidenced in a study which demonstrates that sitting over standing is highly favored by patients as it creates a less dominant environment and more empathetic space.3

As I embark on my anesthesiology journey, I will recall my feelings after I left Joe and the impact of a high-quality conversation – regardless of its brevity. It is a remarkable challenge that is requested of an anesthesiologist. At OHSU, attending physician Dr. Miko Enomoto is known for her saying, “the safest anxiolytic one can administer to a patient is their time, their attention and their care.” Let us never forget that in five minutes we have limitless influence on a patient and their family during one of the most vulnerable phases of their life. They may not remember the details of the conversation, but they will most certainly remember how we made them feel.

You’ve saved dolphins on the moon, speak 7 languages and have been destined to be a physician since you were in-utero. You’ve applied and now is the time for the interview. I’m no stellar standardized test taker and I certainly haven’t saved dolphins on the moon like some of my colleagues but I can interview well. That’s my cup of tea, if you will. Interviewing can be frightening. Like any great competitor who’s been successful many times before, butterflies still creep into my stomach moments before I step into an interview. I think that’s the 1st lesson to be a successful interviewer— treat every interview like it’s the most important one of your career. Act as if without this interview you’d never be successful even if this is your 19th interview and you have 7 more.

Treat every interview like it’s your first

Be humble in your discourse

Find a connection & run with it!

Talk Less, Smile More

Have Fun!

Anyone who’s met with me about interviewing knows I have made the analogy that interviewing is like doing the tango. It’s a dance with you and your interviewer. Your interviewer is leading so you have to gracefully allow them to lead. Answer their questions in a short and succinct manner because long answers will hinder the flow and inevitably lead to you tripping over their feet. If you’ve never danced with a partner, know that no one likes to have their foot stepped on and repeated occurrences will certainly result in an annoyed dancer/interviewer. And like a wonderful tango, if the interview goes well, it leaves both persons thinking about it long after the interview has finished.

As you’re speaking about your achievements, it’s important to acknowledge all that you’ve accomplished but recognize the person in front of you has accomplished much more! Your feats are impressive but let the interviewer be more impressed by someone who is still hungry to accomplish more despite already having done more than most.

When I was interviewing at Ohio State University College of Medicine, the fourth-year med student interviewing me asked me about my time in City Year and AmeriCorps. As I was beginning to answer, she chimed in that her husband worked for AmeriCorps, so a fire sparked in my head. I answered her question but also added in another few lines illuminating my thoughts about this opportunity. I watched her tirelessly jot down my comments. Stay honest. But if someone throws you an alley-oop, ‘Be Like Mike,’ and slam it!

I’m going to borrow a line from Hamilton—The Musical. If you haven’t seen it you’re missing out! It’s much more than a play; it’s an eye-opening three-hour artistic masterpiece. In Hamilton, one of the main characters frequently says, “Talk Less. Smile More.” Musical characterization aside, in any interview, if you’re talking more and smiling less, you’re losing. Winning in an interview is as much about your appearance and body language as it is your responses. Understanding who’s leading the conversation is a sure sign that you understand how to act and interact in different social realms.

And have fun. My high school Cross Country/Track coach, Anthony Belber, always said this each time before I raced and I never quite understood how I could have fun when there was so much pressure on the line… until I got older. An interview is an opportunity to show someone that your accomplishments have a human being behind them. It is a chance for you to prove that you are who they think you are. Nothing more, nothing less.